Prostate cancer: get seven questions about the diagnosis

Prostate cancer is the most prevalent among male Brazilians, being the second most common cancer in the population, second only to non-melanoma skin cancer. There are 60,000 new cases estimated annually, according to the National Cancer Institute (Inca). In this scenario, it is extremely important to perform the exams and follow up with the doctor, especially those who are in a group at risk for the disease. With this in mind, we talked to specialists and raised the main questions about the diagnosis of prostate cancer, as well as the tests that need to be done from what age:

Prostate cancer affects only elderly men?

Not exclusively, but mainly. "The average age is 68 to 72 years, but it can be found in young people - mainly of black ethnicity - or in individuals with a strong family history of prostate cancer," explains the oncologist Fabio Kater, coordinator of the Oncology Center of Hospital 9 July. According to oncologist Anderson Silvestrini of the Brazilian Society of Clinical Oncology, about 60 to 70 percent of men age 80 and older may have early prostate cancer.

Does every man need to do the touch exam regardless of age?

Men need to take the touch exam annually from the age of 50, since it is from that age that the incidence increases. "Before this age the examination can be recommended by the doctor for symptomatic persons or people at high risk for the disease, such as obesity and first degree relatives with the diagnosis of the disease," says the oncologist Anderson. The current recommendation of the American Urological Association is that men between the ages of 40 and 54 undergo prostatic evaluation with PSA and rectal examination if they present risk factors for prostate cancer, otherwise routine prostate assessment should be performed in men from the age of 50. However, men of very advanced age - life expectancy below 10 years - who have no symptoms and never had a diagnosis of prostate cancer, may be exempted from the examination by the physician, on the grounds that the diagnosis at that age may not benefit the patient , because the treatment can be very exhaustive and not very effective for someone whose life expectancy is already low. For example, a man who is 90 or 95 years old does not benefit as much from the diagnosis as a younger man, as he is likely to die of other age-related things, and cancer treatment can be debilitating. However, everything should be discussed with a doctor.

I do not have urinary symptoms, do I have to worry about cancer?

Yes, you do. "Prostate cancer in its early stages is asymptomatic, that is, it has no symptoms," says oncologist Gustavo Cardoso Guimarães, director of the Nucleus of Urology at the A.C.Camargo Cancer Center. When the symptoms appear, it means that the lesion is already at a more advanced stage. Difficulty urinating, urinary stress, urinary hesitation, urinary retention, recent erectile dysfunction and blood in urine or sperm are important symptoms for prostate cancer. "Other symptoms are, in more advanced cases, bone pains, often difficult to control," says oncologist Anderson.

Is touch examination the only way to diagnose prostate cancer?

No. "Touch is an important part of the prostate exam, but it may be flawed," says oncologist Gustavo. The correct investigation is done with a complete clinical history, PSA dosage, rectal examination and rectal prostate ultrasound. "PSA is a protein that the normal prostate can produce and the prostate tumor produces much more," explains the oncologist Anderson. According to the oncologist Fabio, these tests give a 95% chance of a diagnosis.

If the PSA is normal, is it not necessary to make the rectal touch?

You may be wondering: if the touch exam can be flawed and my PSA is normal, why follow on this evaluation? According to the oncologist Fabio, 24 to 40% of the tumors do not present high PSA protein dosages, not being detected by the test - but they can be by touch. "The rectal examination also gives us additional information about the prostate, even if unrelated to the malignant disease, such as benign prostatic hyperplasia," says urologist Ravendra. In addition, the touch exam also makes it possible to find polyps and remove skin for biopsy.

Is prostate cancer always severe?

The severity of the disease varies with its extent. The more extensive the disease is, the more serious its prognosis, says the oncologist Anderson. When diagnosed and treated early, it has reduced mortality risks. "However, when diagnosed in a metastatic stage, that is, it has already spread to other organs, the chances of cure are lower," says urologist Ravendra. The experts explain that each case is a case, but once the diagnosis is made, it is necessary to follow the doctor closely and seek the most appropriate treatment for the patient. In Brazil, prostate cancer is the fourth leading cause of cancer death, accounting for 6% of all deaths in this group. It is therefore very important to have regular exams and be aware of the symptoms.

Is it possible to have a preventive prostatectomy?

Preventive prostatectomy is not indicated in any situation. "There are currently researches looking for genetic markers of poor prognosis that could assist in the management of cases of malignant prostate cancer early, but in the absence of malignancy there is no indication of extirpating the prostate," says urologist Ravendra. In addition, withdrawal of the prostate may involve a number of undesirable effects, such as urinary incontinence, erectile dysfunction and impotence. "There is no scientific evidence to justify any prophylactic procedure to prevent prostate cancer," explains the oncologist Fabio. In addition, says the surgeon oncologist Gustavo, many patients with tumors in the prostate can be treated in ways other than surgery, such as radiotherapy or HIFU (focused high frequency ultrasound).

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